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In the wee hours of Friday morning, the latest Republican crusade to repeal Obamacare ended in defeat, as John McCain joined GOP Senate colleagues Lisa Murkowski and Susan Collins in casting no votes on a "skinny repeal" measure. With characteristic bluster, President Trump tweeted shortly after the vote, "3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!" In the end, the GOP promise to repeal and replace the Affordable Care Act so far appears to have done nothing beyond generate scary CBO reports and threatening presidential tweets, while further destabilizing the insurance markets.

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A surprise no vote from John McCain derailed the party's health care efforts, at least for now

In response to Republican attacks, Democrats circled around Obamacare, making it clear that repealing the ACA would result in catastrophe, with millions of Americans losing their insurance.

At the same time, more progressive voices see the Republican debacle as an opportunity for Democrats to push bolder policy ahead of the 2018 midterms. As he recently raced around the country to combat the GOP effort, Bernie Sanders – still the most popular politician in America – stressed that the ultimate goal should be a single-payer system, where the government covers health care costs for all Americans. Fellow Sen. Elizabeth Warren has also advised Democrats to get behind the idea and run on single-payer in 2018.

And there are already candidates heeding that call. Randy Bryce – a burly iron-worker with a thick mustache and the popular @IronStache Twitter account – plans to unseat Paul Ryan by attacking the House Speaker's repeal-and-replace bill and pushing for Medicare for All. His campaign kicked off to an auspicious start when his first ad, on health care, went viral. He's not surprised it was so popular. "I see it as an intergenerational issue – it's something that affects everybody," he tells Rolling Stone. "Everybody can agree that it's hard to do anything unless you are healthy."

Amy Vilela is primarying a progressive Nevada Democrat because he refused to sign on to a Medicare for All bill. A businesswoman by trade, Vilela never thought she'd run for political office. But losing a child changes you in ways you can't imagine, especially when you're sure she'd still be alive if America had a functional health care system. "A $1,000 test would have allowed doctors to diagnose her and save her life," Vilela says. "Your care in this country is solely determined by what kind of insurance you have."

In 2014, Vilela's 22-year-old daughter Shalynne went to the Centennial Hills Hospital Emergency room displaying classic symptoms of deep vein thrombosis, a blood clot in her leg. The family says hospital staff refused Shalynne's pleas for treatment because she told them she didn't have insurance, sending her away despite the 8-out-of-10 pain she reported. A few weeks later, the clot travelled to her lungs, causing a massive pulmonary embolism. The last thing she'd googled on her phone was "symptoms of a heart attack" so her mom thinks she spent her last moments panicked and in pain.

Vilela got to the hospital after her daughter had already lost consciousness; she remembers the lead smell of blood in the room as Shalynne sank into brain death. She made the unbearable decision to take her daughter off life support so her organs could help others. "She always talked about how much she respected organ donors," Vilela says.

At first, Vilela went crazy with grief and could barely get out of bed. Then she decided to fight – to share Shalynne's story so people would understand that no one's safe in a profit-driven health care system. "Being a businesswoman in the finance field, I understand profit motive," she says. "My experience has made me understand more fully that there are things in this country that should not have profit in them."She used her daughter's story to lobby hard against the Republican effort to kill Obamacare, but after a heated exchange with freshman Rep. Ruben Kihuen she decided that she – and the Democratic Party – needed to do more and demand Medicare for All.

Amy VilelaDeed DeBruno

"They had to pull me away from her casket because I was screaming and crying, and I knew that was the last moment that I was going to touch my daughter forever," Vilela told Kihuen during the town hall. Kihuen nodded empathetically. But when she asked why he hadn't put his name on HR 676, the Medicare for All bill, Kihuen countered that his priority is defending the Affordable Care Act against Republican attacks. Amy pointed out that the ACA didn't save her daughter.

It was a tough decision, she says, but she decided to primary Kihuen because she believes universal health care is a more realistic goal than many elected officials seem to realize. "We have more power than we assume. We can come together as a people and help create the transformation needed to achieve Medicare for All. We don't have time to waste," she says.

Kihuen supports health care as a human right, but the idea that Medicare for All is an absurd leftist impossibility continues to permeate the discourse around health care reform. Exhibiting a suspicious amount of concern for the Democratic Party's future, the right-wing National Reviewargued that if Democrats embraced single-payer, they'd be in danger of following the "Bernie Sanders wing of their party off the proverbial cliff." In another strange twist in the final hours of Republicans' repeal-and-replace effort last week, GOP lawmakers goaded Democrats with a sham proposal for single-payer.

But 33 percent of Americans support single-payer, a five percent increase since January, according to a Pew poll published in June. That number might suggest many aren't sure what single-payer means, since the same survey showed 60 percent of Americans think the federal government should provide health care coverage to all Americans. Even the Harvard Business Review, hardly a bastion of leftism, has argued that America might be ready for a single-payer system.

Like many Americans, Paul Ryan's challenger, Randy Bryce, worries about health insurance, which is why he thinks it's a winning issue against the House speaker, who appears singularly devoted to taking away health coverage from people.

Bryce is in a union, which means he can afford insurance for his young son – but he only has enough money for expenses if he works enough hours. In the winter, that can be difficult.

"I'm concerned about my son," Bryce says. "Let's say he goes sledding. What if he runs into a tree and gets hurt? Am I going to have to skip other bills to pay for his medicine?"

A cancer survivor, Bryce didn't have insurance when he battled his disease. He was lucky enough to get help at a local medical college. "I was like a guinea pig!" he jokes.

Bryce's mother, who has multiple sclerosis (and who starred in his viral campaign ad), has insurance because her husband was a cop. What if she'd gotten an incurable disease without insurance, he wonders?

Since the launch of his campaign, Bryce says he's gotten heart-warming letters from older women like his mother thanking him for running against Ryan. "You gotta get rid of this guy, he's trying to take away our health care," he says they write as they send in their donations, which tend to be around $5. It's not a lot of money, but it means a lot to him. "I get so much energy being committed to getting rid of Paul Ryan," he says. "Because, we're not 'losing' health care – they're actively trying to take it away from us."

Bryce served in the U.S. Army in Honduras, so he's seen what a banana republic looks like. He says America is heading in that direction, and he wants to stop it – by fighting what he calls "banana Republicans" like Ryan. In a move that might signal concern from Ryan's team, they're targeting Bryce as a "liberal agitator." But he's more than happy to take on that label. "It takes agitation to get the dirt out," he says. "I'm part of the agitate, educate, organize model."

As for whether his position on health appears too extreme in the current climate, Bryce says, "If they consider it 'too far left' for people to have the ability to see a doctor, then that's more of a problem with where they're coming from than with my position."

Bryce also wonders why Ryan hasn't shown his face in a traditional town hall in nearly two years. "It's not that he doesn't have time. He's traveling all around the country going to these fundraisers. People are upset about that," Bryce says. "Meanwhile, he's trying to take away health care. I don't know whose 'House' he claims to be speaking for, but it's not my house.

"He's gone the opposite direction of what we need," he says. "He doesn't care about us."